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Burkholderia pseudomallei Detection among Hospitalized Patients, Sarawak
Jessica Y Choi1,2, King Ching Hii3, Emily S Bailey1,2
1Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.
Abstract:
Burkholderia pseudomallei infections are prevalent in Southeast Asia and northern Australia and often misdiagnosed. Diagnostics are often neither sensitive nor rapid, contributing up to 50% mortality rate. In this 2018 pilot study, we enrolled 100 patients aged 6 months-79 years from Kapit Hospital in Sarawak, Malaysia, with symptoms of B. pseudomallei infection. We used three different methods for the detection of B. pseudomallei: a real-time polymerase chain reaction (PCR) assay, a rapid lateral flow immunoassay, and the standard-of-care bacterial culture-the gold standard. Among the 100 participants, 24 (24%) were positive for B. pseudomallei by one or more of the detection methods. Comparing the two individual diagnostic methods against the gold standard-bacterial culture-of any positive test, there was low sensitivity for each test (25-44%) but high specificity (93-98%). It seems clear that more sensitive diagnostics or a sensitive screening diagnostic followed by specific confirmatory diagnostic is needed for this disease.
Insights
Diagnosing Burkholderia pseudomallei infections requires better tools. Current rapid tests for this prevalent disease show low sensitivity, necessitating improved diagnostic methods for better patient outcomes.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Diagnostic Development
Background:
- * Burkholderia pseudomallei infections are common in Southeast Asia and Australia, frequently misdiagnosed due to limitations in current diagnostic methods.
- * High mortality rates (up to 50%) are associated with these infections, underscoring the urgent need for improved diagnostic sensitivity and speed.
- * Existing diagnostics often lack the necessary sensitivity and rapidity for timely and accurate detection of B. pseudomallei.
Purpose of the Study:
- * To evaluate the diagnostic performance of real-time polymerase chain reaction (PCR) and a rapid lateral flow immunoassay compared to bacterial culture for B. pseudomallei detection.
- * To assess the sensitivity and specificity of these diagnostic methods in a pilot study involving patients with suspected B. pseudomallei infection.
- * To identify the need for more sensitive diagnostic strategies for B. pseudomallei infections.
Main Methods:
- * A pilot study involving 100 patients from Sarawak, Malaysia, with symptoms suggestive of B. pseudomallei infection.
- * Utilized three detection methods: bacterial culture (gold standard), real-time PCR, and a lateral flow immunoassay.
- * Compared the performance of PCR and lateral flow immunoassay against bacterial culture results.
Main Results:
- * 24% of participants tested positive for B. pseudomallei by at least one method.
- * Both real-time PCR and the lateral flow immunoassay demonstrated low sensitivity (25-44%) when compared to bacterial culture.
- * High specificity (93-98%) was observed for both individual diagnostic methods.
- * Bacterial culture confirmed B. pseudomallei in a subset of patients.
Conclusions:
- * Current diagnostic methods for Burkholderia pseudomallei, including real-time PCR and lateral flow immunoassays, exhibit insufficient sensitivity for reliable detection.
- * The high specificity of these tests is noted, but low sensitivity limits their clinical utility as standalone diagnostics.
- * Development of more sensitive diagnostic assays or a combination of sensitive screening followed by specific confirmatory testing is crucial for improving the management of B. pseudomallei infections.
